Effectiveness and Safety of Transplantation of the Stromal Vascular Fraction of Autologous Adipose Tissue for Wound Healing in the Donor Site in Patients with Third-Degree Skin Burns: A Randomized Trial

Abstract

Background The quality of the wound healing at the donor site significantly determines the overall condition of the burn patient, the extent of wound fluid and protein losses, the severity of any systemic in-flammatory reaction, and the intensity of the pain syndrome. It is known that the stromal vas-cular fraction (SVF) has a beneficial effect on the healing of wound defects. This study is aimed at assessing the safety and effectiveness of the application of the SVF of autologous adipose tis-sue to stimulate wound healing of the donor site in patients with burns. Methods This placebo-controlled clinical study included 38 patients with third-degree thermal skin burns. The patients underwent liposuction, enzymatic isolation of the SVF, and intradermal injection of the preparation into the wounds in the donor site, followed by tewametry, cutome-try, thermography and biopsy after 12 days. Quantitative indicators were compared using the Mann-Whitney test for unrelated groups and the Wilcoxon test for related groups. Spearman's rank correlation coefficient (RS) was used to assess the correlation Results Epithelization of the wounds in all patients was seen over an average area of 88 (84;92) %, there being no significant differences between the actual and the control wound sites for this parameter. Transdermal water loss in the test wound sites was 2 times lower than in the control sites ( P = 0.001). The wound donor sites regained their temperature distribution faster than the control sites ( P = 0.042). Histological preparations of the skin of the wound sites revealed that their epidermal layer was 19% thicker compared to the controls ( P = 0.043). It should be noted that five adverse events related to manipulations in the postoperative period were registered. Conclusion Transplantation of SVF autologous adipose tissue into the wound area in most clinical cases proceeded without complications. The area of epithelialization of wound areas af-ter the introduction of SVF did not change, although a significant decrease in transdermal water loss was observed in the wound areas with an improvement in their thermoregulation and an increase in the thickness of the epidermis.

Diagnosis of structure of donor site skin in patients with burns and sepsis according to ultra-high-frequency ultrasound

“…The risk of slow skin restoration in the donor area is significantly higher in patients who have survived sepsis. It may be advisable to use means of stimulating regenerative processes at the donor site [1].…”

“…Skin structure and the number of skin derivatives in the donor area are critical parameters on which the quality of the dermal graft depends. Rapid restoration of the skin at the site of donor wounds is necessary not only to increase the amount of plastic resources, but also to reduce wound losses and reduce pain intensity [1]. In this case, the speed of skin restoration depends on the overall severity of the patient's condition, the stage of development of the burn disease, and the presence of systemic complications.…”